Impact of Sarcopenia on Outcomes Following Resection of Pancreatic Adenocarcinoma

Peter Peng, Omar Hyder, Amin Firoozmand, Peter Kneuertz, Richard D. Schulick, Donghang Huang, Martin Makary, Kenzo Hirose, Barish Edil, Michael A. Choti, Joseph Herman, John L. Cameron, Christopher L. Wolfgang, Timothy M. Pawlik

Research output: Contribution to journalArticlepeer-review

317 Scopus citations


Introduction: Assessing patient-specific risk factors for long-term mortality following resection of pancreatic adenocarcinoma can be difficult. Sarcopenia-the measurement of muscle wasting-may be a more objective and comprehensive patient-specific factor associated with long-term survival. Methods: Total psoas area (TPA) was measured on preoperative cross-sectional imaging in 557 patients undergoing resection of pancreatic adenocarcinoma between 1996 and 2010. Sarcopenia was defined as the presence of a TPA in the lowest sex-specific quartile. The impact of sarcopenia on 90-day, 1-year, and 3-year mortality was assessed relative to other clinicopathological factors. Results: Mean patient age was 65.7 years and 53.1 % was male. Mean TPA among men (611 mm2/m2) was greater than among women (454 mm2/m2). Surgery involved pancreaticoduodenectomy (86.0 %) or distal pancreatectomy (14.0 %). Mean tumor size was 3.4 cm; 49. 9 % and 88.5 % of patients had vascular and perineural invasion, respectively. Margin status was R0 (59.0 %) and 77.7 % patients had lymph node metastasis. Overall 90-day mortality was 3.1 % and overall 1- and 3-year survival was 67.9 % and 35.7 %, respectively. Sarcopenia was associated with increased risk of 3-year mortality (HR = 1.68; P < 0.001). Tumor-specific factors such as poor differentiation on histology (HR = 1.75), margin status (HR = 1.66), and lymph node metastasis (HR = 2.06) were associated with risk of death at 3-years (all P < 0.001). After controlling for these factors, sarcopenia remained independently associated with an increased risk of death at 3 years (HR = 1.63; P < 0.001). Conclusions: Sarcopenia was a predictor of survival following pancreatic surgery, with sarcopenic patients having a 63 % increased risk of death at 3 years. Sarcopenia was an objective measure of patient frailty that was strongly associated with long-term outcome independent of tumor-specific factors.

Original languageEnglish (US)
Pages (from-to)1478-1486
Number of pages9
JournalJournal of Gastrointestinal Surgery
Issue number8
StatePublished - Aug 2012


  • Morbidity
  • Mortality
  • Outcomes
  • Pancreas surgery
  • Sarcopenia

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology


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